Following Up on Patients with Complete 3D Printed Dentures Made with Hybrid Nanocomposite

Researchers from Turkey and Romania have come together recently to finish a project as they evaluate patients in a follow-up study, outlined in ‘Eighteen Months Follow-Up with Patient-Centered Outcomes Assessment of Complete Dentures Manufactured Using a Hybrid Nanocomposite and Additive CAD/CAM Protocol.’ Initially, patients received 3D printed dentures made from a composite material, poly(methyl methacrylate) (PMMA)–nanoTiO2.

Thirty-five patients participated in the study, as researchers evaluated the effectiveness of their dentures later. The new material being used is critical as previously other materials and techniques reflected poor fit and resistance. Here, the authors were relying on innovative nanotechnology for the creation of materials with ‘improved characteristics.’

“Due to the high demand for rapid, accurate, and resistant material suitable for long‐term 3D‐printed complete dentures manufacturing, we proposed an improved nanocomposite based on poly(methyl methacrylate) with titanium dioxide nanoparticle inclusions,” explained the authors. “The newly obtained poly(methyl methacrylate)–TiO2 matrix allowed a material with proven antimicrobial action, smooth surface aspect, and better mechanical and thermal characteristics to be obtained, suitable for use with additive technology.

“In order to assess the improved hybrid nanocomposite in clinical environment, a protocol for long‐term DLP 3D‐printed complete denture manufacturing was proposed, and an objective clinical assessment and morphological analysis was performed.”

Along with the long-term clinical assessment and analysis, the researchers also asked each participant to fill out a questionnaire (49 questions) regarding their ‘subjective perceptions’ about treatment. Questions were relevant to:

• Functional limitation
• Pain
• Psychological discomfort
• Physical disability
• Psychological disability
• Social disability
• Handicap

The dentures were created on an EnvisionTEC Perfactory® 3D printer, featuring a layer thickness from 25  μm to 150  μm. Post-processing required dentures to be soaked in a solvent quickly, and then supports were removed, the dentures were polished and then subjected to a light cure bath in post-curing. Patients received their dentures at their third visits, along with post-operative instructions.

SEM images of (a) Dent 100 (not polymerized) and (b) newly obtained nanocomposite (not
polymerized). Low‐angle backscattering electron image of (c) 3D‐printed E‐Dent 100 and (d) newly
obtained 3D‐printed nanocomposite. Titania nanoparticles are marked with yellow circles in subfigures (b) and (d).

(a) SEM images of TiO2 powder; (b) particle measurements for 3D‐printed denture sample.

EDX analysis for the newly obtained 3D‐printed nanocomposite (denture).

Two sets of dentures were broken in the first six months of use, and patients each received a new set to replace them.

Boxplots for the changes in OHIP‐EDENT overall scores.

The dentures were studied 18 months later in the assessment, and the researchers noted ‘satisfactory uniformity,’ with no defects. Patients noted ‘significant improvement’ related to their oral health as the dentures provided good retention and stability.

Slice images using micro‐CT performed on a sample of the 3D‐printed denture.

“The proposed workflow with the nanoTiO2 composite material used is a viable treatment option for patients diagnosed with complete edentulism,” concluded the researchers.

“The results indicate that the OHRQoL was significantly improved, and patients’ satisfaction scores for aesthetic, speech, masticatory efficiency, hygiene, and comfort were significantly higher upon new denture insertion, with these improvements being maintained throughout the entire evaluation period.”

3D printing of dentures continues to be improved around the world, offering an incredible opportunity for medical technicians and patients alike, from those that are made to prevent infection, to removable partials, those that are 3D printed rapidly, and much more.

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